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trainee-led Surgical research collaboratives by nMYFuu3


Dan Beral
• Verb

• 1. to work, one with another; cooperate.

• 2. to cooperate, usually willingly, with an enemy nation,
 especially with an enemy occupying one’s country.
The problem with research..
• Difficult to conduct research on an individual basis during
 a single post

• Network formed by registrars rotating through the region

• Can be exploited to run multicentre trials

• A multitude of benefits
                          & design            Data
   Team leading
                                            & analysis
    & working

                                             Write papers
Enhance CV


& Presentations                         Benefits of                                         Trials
                  Transferable         Collaborative
                     skills                                            Quality of

                                                                                    More clinical
                          Region                           Better                   surgical trials
The West Midlands Experience
• Set up by surgical registrars

• Supported by Professor Dion Morton

• Links with University of Birmingham Clinical Trials Unit
WMRC Studies
• Pancreatitis Study
• Reduction Of Surgical Site Infection using a Novel

• Prospective, multicentre, observer-blinded RCT using
 wound-edge protectors

• Over 500 patients recruited

• NIHR RfPB support
• Dexamethasone Reduces Emesis After Major
 gastrointestinal Surgery

• Funded by Bowel Disease Research Foundation grant

• NIHR Portfolio trial

• Phase III double-blind, multicentre RCT
• Reinforcement Of Closure of Stoma Site

• Prospective, multicentre, double-blind RCT mesh
 (Strattice) vs standard closure

• Pilot complete, recruiting beginning
Pancreatitis Study
• Retrospective, multicentre audit of timing of
 cholecystectomy after gallstone pancreatitis

• Effect on morbidity, readmissions and operative
• Cancer Outcomes Ethnicity Study I

• Retrospective, multicentre study comparing breast cancer
 outcomes of ethnic minority patients vs white patients

• Cancer Outcomes Ethnicity Study II

• Looking at variations in adjuvant therapies received
 between ethnic minorities with breast cancer

• Abstracts: EJSO, BJS and Cancer Research
• Presentations: San Antonio, BASO, SARS
• Clostridium difficile in Hospitals – A Regional Multicentre

• Retrospective analysis of prospectively collected data –
 over 7000 patients identified

• Analyse whether elective colorectal patients have
 enhanced susceptibility to C. diff.

• Control for bowel prep, antibiotic use and infection control
 measures used
• Shift Work Impact on Foundation Training

• Assessment of FY1 knowledge of their acute general
 surgery patients

• Whether any weaknesses are related to having
 clerked/presented the patient
So that’s a good idea then…

              Others                           MeRGS

       YSRC                                            LSRG

        STORC                                      WMRC

                       CERRG            WBRG
The Yorkshire Surgical Research
• Founded June 2011

• Mentor: Professor David Jayne

• Executive Committee:
 • Chairman: Dan Beral
 • Secretary: Gareth Hicks
 • Treasurer: Deena ElSharief
 • New Projects Coordinator: Soroush Sohrabi
 • Communications Secretary: Tak Khong
YSRC Projects
• Many new ideas presented including:

• Surgical Admissions Unit Audit

• PancreatitYS Study

• Prucalopride study

• Pulse Wave Velocity Studies

• Breast Audits
SAU Audit
• Audit of SAU admissions across Yorkshire

• Data collection and pattern analysis

• Generation of future research avenues

• Pilot to take place in Leeds next month
• Pancreatitis – The Yorkshire Study

• Little is known about precise relationship of EtOH to
 alcoholic pancreatitis – dose/type

• Some epidemiological evidence to suggest spirits are
 major cause
Pulse Wave Velocity Studies
• Prognostic value of PWV and serum Troponin
 measurement in prediction of mortality and cardiovascular
 events in patients with Critical Limb Ischaemia pre and
 post intervention

• Prognostic value of PWV and ABPI measurements in
 small and large bowel anastomotic leaks

• Audit being analysed prior to ethics, piloting and funding
The future of collaboratives?
• Progress by individual collaboratives

• Publishing of large, multicentre RCTs

• Inter-collaborative collaboration

• National Collaborative Research Register

• All trainees will one day be members?
International appendicectomy audit
• Appendicitis still remains controversial:

• Diagnostic challenge despite modern radiology

• Persistent negative appendicectomy rate

• High wound infection rates

• High intra-abdominal collection rates

• Laparoscopic vs open?
International appendicectomy audit

• Negative appendicectomy rate
  • Overall negative appendicectomy rate of <20%; 5 to 15% in males
    and 10 to 30% in females5-7.

• Rates of wound infection requiring readmission
  • Wound infection rate of <10%. The highest level of evidence arises
    from a Cochrane review which pooled data from 50 randomised
    trials to find an overall wound infection rate of 5.4% (321/5972)4.
    The inter-quartile range for rates from individual studies was 2.5%
    to 7.6%.
International appendicectomy audit
• Intra-abdominal abscess rate
   • Intra-abdominal abscess rate of <2.5%. The highest level of evidence
     arises from a Cochrane review which pooled data from 45 randomised
     trials to find an overall intra-abdominal abscess rate of 1.4%
     (78/5577)4. The inter-quartile range for rates from individual studies
     was 0% to 2.3%.

• Provision of laparoscopic appendicectomy
  • Routine use of laparoscopy. Guidelines from the Society of American
    Gastrointestinal and Endoscopic Surgeons (SAGES) recommend
    routine use of laparoscopy unless contra-indicated11. The impact of
    laparoscopy on the main outcome measures will be assessed. The
    highest level of evidence arises from a Cochrane review of 57
    randomised trials, which showed that LA was associated with fewer
    wound infection (OR 0.43; CI 0.34 to 0.54), more intra-abdominal
    abscesses (OR 1.87; CI 1.19 to 2.93) and a marginal increase in
    duration of surgery (10 minutes [CI 6 to 15])4.
International appendicectomy audit

• 1000 patients

• 1st May – 30 June

• 30 day follow up
What can I do?
• Trainees:

• Join in!

• Come to the meetings

• Take part in studies

• Get published

• Write your CV and get on in your career!
What can I do?
• Consultants:

• Support your trainees

• Encourage ideas and participation

• Allow your patients to participate in collaborative studies

• Use the collaboratives to get your own projects done!
Thank you
• Any questions?

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